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R L Thompson

Publications and source records attributed to R L Thompson.

At least 19 recordsLinked to original sources
PubMed2001

Dietary antioxidants and asthma in adults: population-based case-control study.

A protective role for dietary antioxidants in asthma has been proposed. However, epidemiological evidence to implicate antioxidant vitamins is weak, and data on the role of flavonoid-rich foods and antioxidant trace elements are lacking. We carried out a population-based case-control study in South London, UK, to investigate whether asthma is less common and less severe in adults who consume more dietary antioxidants. Participants were aged 16-50 yr and registered with 40 general practices. Asthma was defined by positive responses to a standard screening questionnaire in 1996, and complete information about usual diet was obtained by food frequency questionnaire from 607 cases and 864 controls in 1997. After controlling for potential confounding factors and total energy intake, apple consumption was negatively associated with asthma (odds ratio [OR] per increase in frequency group 0.89 [95% confidence interval [CI]: 0.82 to 0.97]; p = 0.006). Intake of selenium was also negatively associated with asthma (OR per quintile increase 0.84 [0.75 to 0.94]; p = 0.002). Red wine intake was negatively associated with asthma severity. The associations between apple and red wine consumption and asthma may indicate a protective effect of flavonoids. The findings for dietary selenium could have implications for health policy in Britain where intake has been declining.

Adolescent↗
PubMed2001

Early intervention with high-dose acyclovir treatment during primary herpes simplex virus infection reduces latency and subsequent reactivation in the nervous system in vivo.

There remains a lack of agreement on the effect of antiviral therapy on herpes simplex virus (HSV) latency and subsequent reactivation. To gain insight into this important issue, a single-cell polymerase chain reaction assay was used to quantify the effects of high-dose acyclovir on latent infection in a mouse model. Treatment with 50 mg/kg of acyclovir every 8 h reduced the number of latently infected neurons by >90% when treatment was begun before 24 h after infection and by 80% and 70% when begun at 48 or 72 h after infection, respectively. The biologic significance of these reductions was evaluated by using a well-established in vivo reactivation model. The number of animals in which virus reactivated was reduced significantly, even when acyclovir therapy was delayed until 72 h after infection, a time when animals had developed lesions. These findings indicate that potent antiviral therapy during early primary HSV infection can reduce the magnitude of the latent infection, such that a significant decrease in reactivation is observed.

Acute Disease↗
PubMed2001

Dietary fat intake and prevention of cardiovascular disease: systematic review.

OBJECTIVE: To assess the effect of reduction or modification of dietary fat intake on total and cardiovascular mortality and cardiovascular morbidity. DESIGN: Systematic review. DATA SOURCES: Cochrane Library, Medline, Embase, CAB abstracts, SIGLE, CVRCT registry, and biographies were searched; trials known to experts were included. INCLUDED STUDIES: Randomised controlled trials stating intention to reduce or modify fat or cholesterol intake in healthy adult participants over at least six months. Inclusion decisions, validity, and data extraction were duplicated. Meta-analysis (random effects methodology), meta-regression, and funnel plots were performed. RESULTS: 27 studies (30 902 person years of observation) were included. Alteration of dietary fat intake had small effects on total mortality (rate ratio 0.98; 95% confidence interval 0.86 to 1.12). Cardiovascular mortality was reduced by 9% (0.91; 0.77 to 1.07) and cardiovascular events by 16% (0.84; 0.72 to 0.99), which was attenuated (0.86; 0.72 to 1.03) in a sensitivity analysis that excluded a trial using oily fish. Trials with at least two years' follow up provided stronger evidence of protection from cardiovascular events (0.76; 0.65 to 0.90). CONCLUSIONS: There is a small but potentially important reduction in cardiovascular risk with reduction or modification of dietary fat intake, seen particularly in trials of longer duration.

Cardiovascular Diseases↗
PubMed2001

Dietary advice given by a dietitian versus other health professional or self-help resources to reduce blood cholesterol.

BACKGROUND: The average level of blood cholesterol is an important determinant of the risk of coronary heart disease. Blood cholesterol can be reduced by dietary means. Although dietitians are trained to provide dietary advice, for practical reasons it is also given by other health professionals and occasionally through the use of self-help resources. OBJECTIVES: To assess the effects of dietary advice given by a dietitian compared with another health professional, or the use of self-help resources, in reducing blood cholesterol in adults. SEARCH STRATEGY: We searched The Cochrane Library (to Issue 2 1999), MEDLINE (1966 to January 1999), EMBASE (1980 to December 1998), Cinahl (1982 to December 1998), Human Nutrition (1991 to 1998), Science Citation Index, Social Sciences Citation Index, hand searched conference proceedings on nutrition and heart disease, and contacted experts in the field. SELECTION CRITERIA: Randomised trials of dietary advice given by a dietitian compared with another health professional or self-help resources. The main outcome was difference in blood cholesterol between dietitian groups compared with other intervention groups. DATA COLLECTION AND ANALYSIS: Two reviewers independently extracted data and assessed study quality. MAIN RESULTS: Eleven studies with 12 comparisons were included, involving 704 people receiving advice from dietitians, 486 from other health professionals and 551 people using self-help leaflets. Four studies compared dietitian with doctor, seven with self-help resources, and one compared dietitian with nurse. Participants receiving advice from dietitians experienced a greater reduction in blood cholesterol than those receiving advice only from doctors (-0.25 mmol/L (95% CI -0.37, -0.12 mmol/L)). There was no statistically significant difference in change in blood cholesterol between dietitians and self-help resources (-0.10 mmol/L (95% CI -0.22, 0.03 mmol/L)). No statistically significant differences were detected for secondary outcome measures between any of the comparisons with the exception of dietitian versus nurse for HDLc, where the dietitian groups showed a greater reduction (-0.06 mmol/L (95% CI -0.11, -0.01)). No significant heterogeneity between the studies was detected. REVIEWER'S CONCLUSIONS: Dietitians were better than doctors at lowering blood cholesterol in the short to medium term, but there was no evidence that they were better than self-help resources. The results should be interpreted with caution as the studies were not of good quality and the analysis was based on a limited number of trials. More evidence is required to assess whether change can be maintained in the longer term. There was no evidence that dietitians provided better outcomes than nurses.

Cholesterol↗
PubMed2001

Natural history of vancomycin-resistant enterococcal colonization in liver and kidney transplant recipients.

At Mayo Medical Center (Rochester, MN), surveillance rectal (and other-site) cultures have been routinely collected from liver transplant recipients as part of a selective bowel decontamination program. Beginning in 1995, vancomycin-resistant enterococcus (VRE) colonization and infection were identified in Mayo Clinic liver and kidney transplant patients through our surveillance cultures. The purpose of this study is to describe the natural history of VRE colonization in this patient population. Fifty-two patients with VRE colonization (predominantly with a single vanB clone) were identified from September 1995 through December 1997. Five hundred ninety cultures were reviewed for this study (mean, 11.3 cultures/patient). The median time from initial VRE colonization to the last surveillance culture obtained was 306 days (range, 1 to 1,393 days). VRE infection was documented in 6 patients (11.3%). Eighteen patients (35%) met the criteria for clearance of VRE colonization, defined as VRE-negative rectal culture results on at least 3 consecutive occasions greater than 1 week apart. However, VRE was detected on subsequent surveillance cultures from 2 of these patients (11% relapse rate). Of the remaining 34 patients, 16 remained colonized with VRE and 18 did not meet the definition for clearance of VRE colonization because of incomplete follow-up. This study documents that VRE colonization usually persists for months to years in liver and kidney transplant patients.

Electrophoresis, Gel, Pulsed-Field↗
PubMed2001

Herpes simplex virus type 1 latency-associated transcript gene promotes neuronal survival.

A complex interaction has evolved between the host's peripheral nervous system (PNS) and herpes simplex virus type 1 (HSV-1). Sensory neurons are permissive for viral replication, yet the virus can also enter a latent state in these cells. The interplay of viral and neuronal signals that regulate the switch between the viral lytic and latent states is not understood. The latency-associated transcript (LAT) regulates the establishment of the latent state and is required for >65% of the latent infections established by HSV-1 (R. L. Thompson and N. M. Sawtell, J. Virol. 71:5432-5440, 1997). To further investigate how LAT functions, a 1.9-kb deletion that includes the entire LAT promoter and 827 bp of the 5' end of the primary LAT mRNA was introduced into strain 17syn+. The wild-type parent, three independently derived deletion mutants, and two independently derived genomically rescued variants of the mutants were analyzed in a mouse ocular model. The number of latent sites established in trigeminal ganglion (TG) neurons was determined using a single-cell quantitative PCR assay for the viral genome on purified TG neurons. It was found that the LAT null mutants established ~75% fewer latent infections than the number established by the parental strain or rescued variant. The reduced establishment phenotype of LAT null mutants was due at least in part to a dramatic increase in the loss of TG neurons in animals infected with the LAT mutants. Over half of the neurons in the TG were destroyed following infection with the LAT mutants, and this was significantly more than were lost following infection with wild type. This is the first demonstration that the HSV LAT locus prevents the destruction of sensory neurons. The death of these neurons did not appear to be the result of increased apoptosis as measured by a terminal deoxynucleotidyltransferase-mediated dUTP-biotin nick end labeling assay. Animals latently infected with the LAT null mutants reactivated less frequently in vivo and this was consistent with the reduction in the number of neurons in which latency was established. Thus, one function of the LAT gene is to protect sensory neurons and enhance the establishment of latency in the PNS.

Animals↗
PubMed2001

Staphylococcal toxic shock syndrome. Suspicion and prevention are keys to control.

TSS is still very much with us and can mimic a variety of disorders. Early recognition of the various manifestations of this multisystem disease and careful inspection of possible sites of infection, removal of tampons, and debridement of surgical wounds, along with early aggressive supportive treatment and antibiotic therapy, are critical to prevent complications and ensure recovery. In menstrual TSS, prevention of subsequent relapses is achieved by patient education about proper use of tampons and recognition of early signs of the disease.

Algorithms↗
PubMed2001

Novel quantitative assays for estimating the antimicrobial activity of fresh garlic juice.

Novel agar diffusion and broth dilution assays were developed for quantitatively estimating the antimicrobial activity of fresh garlic juice. Bacteria found to be inhibited by garlic juice in agar diffusion assay included two gram-positive and five gram-negative species. Leuconostoc mesenteroides was not inhibited. Escherichia coli B-103 (HB101, with pJH101, ampicillin resistant, 100 microg ml(-1)) was inhibited and chosen as the standard culture for quantitative assays. The agar diffusion assay was based on the slope ratio method, where the slope of dose response for garlic juice was divided by the slope of dose response for methylmethane thiosulfonate (MMTSO2). Juice from fresh garlic varied in activity between 1.76 and 2.31 microg of MMTSO2 per mg of garlic juice. The activity of juice decreased during 11 months of storage of garlic cloves at 5 degrees C from 2.31 to less than 0.1 microg of MMTSO2 per mg of juice. The broth dilution assay also used the E. coli B-103 culture, which permitted selective enumeration of this bacterium when 100 microg ml(-1) of ampicillin was incorporated into the enumerating agar. Selective enumeration was essential since the garlic juice was not sterile and, thus, contained natural flora. Growth of E. coli was unaffected by 0.1%, delayed by 0.25%, and completely inhibited at 0.5 and 2% garlic juice in broth during 24 h of incubation at 37 micro C. The minimum inhibition concentration of garlic juice by broth dilution assay was, thus, estimated to be 0.5%, which is equivalent to 3.46 microg of MMTSO2 per mg of garlic juice by the agar diffusion assay.

Bacteria↗
PubMed2000

Reduced or modified dietary fat for prevention of cardiovascular disease.

BACKGROUND: Reduction or modification of dietary fat can improve total cholesterol levels, but may also have a variety of effects, both positive and negative, on other cardiovascular risk factors. OBJECTIVES: The aim of this systematic review was to assess the effect of reduction or modification of dietary fats on total and cardiovascular mortality and cardiovascular morbidity over at least 6 months, using all available randomized clinical trials. SEARCH STRATEGY: The Cochrane Library, MEDLINE, EMBASE, CAB Abstracts, CVRCT registry and related Cochrane Groups' trial registers were searched through spring 1998, SIGLE to January 1999. Trials known to experts in the field and biographies were included through May 1999. SELECTION CRITERIA: Trials fulfilled the following criteria: 1) randomized with appropriate control group, 2) intention to reduce or modify fat or cholesterol intake (excluding exclusively omega-3 fat interventions), 3) not multi factorial, 4) healthy adult humans, 5) intervention at least six months, 6) mortality or cardiovascular morbidity data available. Inclusion decisions were duplicated, disagreement resolved by discussion or a third party. DATA COLLECTION AND ANALYSIS: Rate data were extracted by two independent reviewers and meta-analysis performed using random effects methodology. Meta-regression and funnel plots were used. MAIN RESULTS: Twenty seven studies were included (40 intervention arms, 30,901 person-years). There was no significant effect on total mortality (rate ratio 0.98, 95% CI 0.86 to 1.12), a trend towards protection form cardiovascular mortality (rate ratio 0.91, 95% CI 0. 77 to 1.07), and significant protection from cardiovascular events (rate ratio 0.84, 95% CI 0.72 to 0.99). The latter became non-significant on sensitivity analysis. Trials where participants were involved for more than 2 years showed significant reductions in the rate of cardiovascular events and a suggestion of protection from total mortality. The degree of protection from cardiovascular events appeared similar in high and low risk groups, but was statistically significant only in the former. REVIEWER'S CONCLUSIONS: The findings are suggestive of a small but potentially important reduction in cardiovascular risk in trials longer than two years. Lifestyle advice to all those at high risk of cardiovascular disease (especially where statins are unavailable or rationed), and to lower risk population groups, should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturates.

Cardiovascular Diseases↗
PubMed2000

A cross-sectional survey of the opinions on weight loss treatments of adult obese patients attending a dietetic clinic.

OBJECTIVE: To investigate the views and opinions on weight loss treatments of adult obese patients attending a dietetic clinic. DESIGN: Cross-sectional survey. SUBJECTS: 161 adults attending dietetic outpatients clinics in Portsmouth for obesity with a body mass index of at least 30 kg/m2. MEASUREMENTS: Self-administered questionnaire developed from a series of focus groups with obese adults. Key topics were previous attempts to lose weight, methods used, the role of physical activity and patients' views about treatment from health professionals. RESULTS: The preferences and usefulness of different methods to lose weight varied according to the number of attempts to lose weight, gender, age, body mass index and medical condition of the patient. Men were less likely to use special slimming products, attend slimming groups and swimming than women (odds ratios (95% confidence interval), 0.1 (0.03-0.6) for slimming groups other than Weight Watchers, 0.3 (0.1-0.80) for special slimming products and 0.3 (0.1-0.6) for swimming). Men were more likely to use physical activity (2.6 (1.1-6.2)) and in particular walking (3.7 (1.0-13.6)) and cycling (2.8 (1.0-7.6)) and were more likely to see the dietitian (3.8 (1.4-9.9)) than women. Those with more than 10 attempts to lose weight were more likely to see the dietitian (3.6(1.6-8.2)), use Weight Watchers (2.5 (1.1-5. 6)) and newspapers and magazines (4.4 (1.8-10.9)) than those with fewer attempts. The younger age group were more likely to use more vigorous forms of exercise (4.2 (1.6-11.2) for keep fit and 3.7 (1. 5-9.6) for cycling) than the older subjects. The most obese were more likely to have negative views on their treatment by health professionals (4.4 (1.9-9.8) 'chairs are never big enough' and 4.0 (1.8-8.8) 'I am regarded as a second class citizen') than those who were less obese. Those without a medical condition were more likely to exercise (2.8 (1.3-6.3)) and use books (4.8 (2.0-11.2)) than those with a medical condition. CONCLUSION: The views of obese people should be considered when planning services for the treatment of obesity and a variety of options should be available. International Journal of Obesity (2000) 24, 164-170

Adolescent↗
PubMed2000

Comparison of protein A gene sequencing with pulsed-field gel electrophoresis and epidemiologic data for molecular typing of methicillin-resistant Staphylococcus aureus.

The epidemiologic relatedness of methicillin-resistant Staphylococcus aureus (MRSA) isolates is currently determined by analysis of chromosomal DNA restriction patterns by pulsed-field gel electrophoresis (PFGE). We have evaluated an alternative typing system (MicroSeq StaphTrack Kit; Perkin-Elmer Biosystems) based on the sequence analysis of the chromosomally encoded polymorphic repeat X region of the S. aureus protein A (spa) gene. A total of 69 clinical MRSA isolates were divided into 18 groups according to the number and nucleotide sequences of the spa repeats. Molecular typing results obtained both by spa sequencing and from the PFGE patterns were concordant except for one group, which contained 20 isolates recovered over a 2-year period from hospitalized patients at the Mayo Clinic. Although the spa typing patterns were indistinguishable for those isolates, PFGE analysis yielded seven related but distinguishable patterns. Further coagulase gene sequence analysis subtyped those 20 strains into four groups which followed distinct temporal and geographic distributions. During a 2-year epidemic period there were up to 7 fragment changes in PFGE patterns among epidemiologically related isolates, suggesting that PFGE may be unsuitable for long-term typing of strains involved in epidemics. Although more limited than PFGE in discriminatory power, spa sequencing analysis could be used as a screening method for typing of MRSA strains because of the shorter turnaround time, ease of use, and the inherent advantages of sequence analysis, storage, and sharing of information.

Animals↗
PubMed2000

Replication of herpes simplex virus type 1 within trigeminal ganglia is required for high frequency but not high viral genome copy number latency.

The replication properties of a thymidine kinase-negative (TK(-)) mutant of herpes simplex virus type 1 (HSV-1) were exploited to examine the relative contributions of replication at the body surface and within trigeminal ganglia (TG) on the establishment of latent infections. The replication of a TK(-) mutant, 17/tBTK(-), was reduced by approximately 12-fold on the mouse cornea compared to the rescued isolate 17/tBRTK(+), and no replication of 17/tBTK(-) in the TG of these mice was detected. About 1.8% of the TG neurons of mice infected with 17/tBTK(-) harbored the latent viral genome compared to 23% of those infected with 17/tBRTK(+). In addition, the latent sites established by the TK(-) mutant contained fewer copies of the HSV-1 genome (average, 2.3/neuron versus 28/neuron). On the snout, sustained robust replication of 17tBTK(-) in the absence of significant replication within the TG resulted in a modest increase in the number of latent sites. Importantly, these latently infected neurons displayed a wild-type latent-genome copy number profile, with some neurons containing hundreds of copies of the TK(-) mutant genome. As expected, the replication of the TK(-) mutant appeared to be blocked prior to DNA replication in most ganglionic neurons in that (i) virus replication was severely restricted in ganglia, (ii) the number of neurons expressing HSV proteins was reduced 30-fold compared to the rescued isolate, (iii) cell-to-cell spread of virus was not detected within ganglia, and (iv) the proportion of infected neurons expressing late proteins was reduced by 89% compared to the rescued strain. These results demonstrate that the viral TK gene is required for the efficient establishment of latency. This requirement appears to be primarily for efficient replication within the ganglion, which leads to a sixfold increase in the number of latent sites established. Further, latent sites with high genome copy number can be established in the absence of significant virus genome replication in neurons. This suggests that neurons can be infected by many HSV virions and still enter the latent state.

Animals↗
PubMed2000

Effects of 4 hand-drying methods for removing bacteria from washed hands: a randomized trial.

OBJECTIVE: To evaluate the effects of 4 different drying methods to remove bacteria from washed hands. SUBJECTS AND METHODS: One hundred adult volunteers participated in this randomized prospective study. All bacterial counts were determined using a modified glove-juice sampling procedure. The difference was determined between the amounts of bacteria on hands artificially contaminated with the bacterium Micrococcus luteus before washing with a nonantibacterial soap and after drying by 4 different methods (cloth towels accessed by a rotary dispenser, paper towels from a stack on the hand-washing sink, warm forced air from a mechanical hand-activated dryer, and spontaneous room air evaporation). The results were analyzed using a nonparametric analysis (the Friedman test). By this method, changes in bacterial colony-forming unit values for each drying method were ranked for each subject. RESULTS: The results for 99 subjects were evaluable. No statistically significant differences were noted in the numbers of colony-forming units for each drying method (P = .72). CONCLUSION: These data demonstrate no statistically significant differences in the efficiency of 4 different hand-drying methods for removing bacteria from washed hands.

Adult↗
PubMed1999

Novel inhibitors of glutamyl-tRNA(Glu) reductase identified through cell-based screening of the heme/chlorophyll biosynthetic pathway.

The metabolite 5-aminolevulinic acid (ALA) is an early committed intermediate in the biosynthetic pathway of heme and chlorophyll formation. In plants, 5-aminolevulinic acid is synthesized via a two-step pathway in which glutamyl-tRNA(Glu) is reduced by glutamyl-tRNA(Glu) reductase (GluTR) to glutamate 1-semialdehyde, followed by transformation to 5-aminolevulinic acid catalyzed by glutamate 1-semialdehyde aminotransferase. Using an Escherichia coli cell-based high-throughput assay to screen small molecule libraries, we identified several chemical classes that specifically inhibit heme/chlorophyll biosynthesis at this point by demonstrating that the observed cell growth inhibition is reversed by supplementing the medium with 5-aminolevulinic acid. These compounds were further tested in vitro for inhibition of the purified enzymes GluTR and glutamate 1-semialdehyde aminotransferase as confirmation of the specificity and site of action. Several promising compounds were identified from the high-throughput screen that inhibit GluTR with an I(0.5) of less than 10 microM. Our results demonstrate the efficacy of cell-based high-throughput screening for identifying inhibitors of 5-aminolevulinic acid biosynthesis, thus representing the first report of exogenous inhibitors of this enzyme.

Aldehyde Oxidoreductases↗
PubMed1999

The Health Education Authority's health and lifestyle survey 1993: who are the low fruit and vegetable consumers?

STUDY OBJECTIVE: Firstly, to determine the demographic and behavioural characteristics of low fruit and vegetable consumers. Secondly, to investigate whether knowledge and attitudes are barriers to consumption of fruit and vegetables. DESIGN: Cross sectional survey: an interviewer administrated questionnaire was used to assess the demographic, knowledge, attitude, and behavioural characteristics of the respondents. SETTING: England. PARTICIPANTS: Random sample of 5553 men and women aged between 16 and 74 years. Response rate 70%. MAIN RESULTS: The main demographic characteristics of the respondents identified as low consumers of fruit and vegetables (less than daily consumption of either fruit or vegetables) were age, sex, and smoking status. The adjusted odds ratios were 2.59 for those aged 16-24 years compared with those aged 45-74 years, 2.17 for men compared with women, and 1.77 for current smokers compared with never smokers. The most important knowledge and attitude statements after adjusting for the demographic variables were disagreeing with the statement "healthy foods are enjoyable" (odds ratio 1.90) and agreeing with the statement "I don't really care what I eat" (odds ratio 1.76). The impact of knowledge seemed less important than attitudes about a healthy diet in characterising a low fruit and vegetable consumer. CONCLUSIONS: These findings are relevant to future strategies for improving intake of fruit and vegetables, but demonstrate the complexity of interventions required, and the dangers inherent in assuming simplistic relations between psychosocial factors and behaviour.

Adolescent↗
PubMed1998

Factors which influence 'healthy' eating patterns: results from the 1993 Health Education Authority health and lifestyle survey in England.

OBJECTIVES: This study explores the factors that influence eating patterns in a nationally representative sample of the English population. DESIGN: Subjects were interviewed in 1993; questions covered basic demographic details, attitudes about nutrition, and they completed a short food frequency questionnaire that had previously been validated. Cluster analysis was used to summarize dietary intake into more or less healthy clusters. SETTING: A random sample of the English population. SUBJECTS: A cross-sectional survey of 5553 men and women (response rate 70%) aged between 16 and 74 years. RESULTS: As defined from the cluster analysis about half the sample were currently reporting a more healthy diet; respondents in the better educated middle-aged demographic cluster were more likely to report eating a more healthy diet than respondents in the younger lower-income family cluster. About three-quarters of all respondents believed that they either already ate a healthy diet or had changed to a healthy diet in the last 3 years. For those respondents who said they were eating a healthy diet about half of them were eating a more healthy diet. Respondents who had not changed their diet were more likely than those who had to believe that healthy foods were just another fashion (men 34% v. 13%; women 30% v. 12%), or expensive (men 50% v. 35%; women 53% v. 40%); they were less likely to care about what they ate (men 45% v. 13%; women 27% v. 7%). Nearly three-quarters of all respondents agreed that experts never agree about what foods are good for you. Younger, low-income families, and those who smoked, were the group least likely to be eating a more healthy diet. CONCLUSIONS: The results of this study suggest that about half of the population has reported a change to a healthier diet over the last 3 years and that overall about half of the population report eating a healthy diet. Those who had not made any change and were currently reporting a less healthy diet were more likely to smoke and come from the 'worse off group in the survey; they were also more likely to hold negative attitudes about healthy eating. A more focused and integrated approach to promoting healthy lifestyle in general is required, while at the same time ensuring that there is continued support for the majority of the population who have made healthy dietary changes.

Adolescent↗